Provider Demographics
NPI:1346366432
Name:ADEWUSI, ADESANMI TUNDE (LPN)
Entity Type:Individual
Prefix:MR
First Name:ADESANMI
Middle Name:TUNDE
Last Name:ADEWUSI
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:MR
Other - First Name:SAMMY
Other - Middle Name:
Other - Last Name:ADEWUSI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:2517 DUNKSFERRY RD APT J102
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-2738
Mailing Address - Country:US
Mailing Address - Phone:215-244-4569
Mailing Address - Fax:
Practice Address - Street 1:2517 DUNKSFERRY RD APT J102
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-2738
Practice Address - Country:US
Practice Address - Phone:215-244-4569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN260109L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse